Provider First Line Business Practice Location Address:
631 E. 62ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-582-8324
Provider Business Practice Location Address Fax Number:
816-746-3886
Provider Enumeration Date:
06/26/2006